RESUMEN
Introduction The presence of impacted third molars is a prevalent problem associated with varying degrees of difficulty in extraction and potential consequences, including pain, swelling, and trismus. According to studies, enzymatic combinations, such as bromelain, rutoside, trypsin, and serratiopeptidase, are known to have a very promising role in reducing inflammation and promoting wound healing. This study compared natural enzymatic agents with corticosteroids for postoperative pain, swelling, and trismus in the impacted lower third molar surgery. Objectives The present study aimed to compare the efficacy of prednisolone, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain, and serratiopeptidase in the postoperative sequelae after surgical extraction of impacted mandibular third molars. The primary objective was to assess the difference in swelling between the three groups. The secondary objectives were to assess the difference in postoperative pain and trismus between the three groups. Materials and methods A total of 150 patients who presented to the department of oral and maxillofacial surgery for surgical removal of an impacted mandibular third molar with a moderately difficult score of 5-7 in the Pederson difficulty index were chosen for a prospective study. Patients were categorized into three groups based on the postoperative drug prescribed. In group 1, prednisolone 10 mg was prescribed; in group 2, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was prescribed; and in group 3, serratiopeptidase 15 mg was prescribed. All patients were prescribed a combination drug of aceclofenac 100 mg and paracetamol 325 mg twice daily as a standard analgesic. Swelling, pain, and trismus in each patient were recorded preoperatively and at postoperative day one and day seven. The Friedman test was employed to evaluate the variation in pain levels within the groups over time, while the Kruskal-Wallis test was utilized to investigate the disparity in pain levels between the groups. The difference in swelling and trismus within the groups across the timeline was measured by repeated measures analysis of variance (ANOVA), and the difference in swelling and trismus between the groups was measured by one-way ANOVA. A p-value below 0.05 was deemed to be statistically significant. Results Group 1 showed less swelling, pain, and trismus on both postoperative day one and day seven compared to group 2 and group 3, which was a statistically significant difference (P < 0.05). It was found that swelling, pain, and trismus measurements in postoperative day one and day seven in group 2 were comparatively less than in group 3. Neither group demonstrated any side effects or other complications during the follow-up period. Conclusion It can be concluded that the use of prednisolone postoperatively following surgical removal of the mandibular third molar provided better relief with regard to pain, trismus, and swelling compared to the enzymatic agents. Among enzymatic agents, a combination of trypsin, chymotrypsin, bromelain, rutoside, and papain was better in reducing pain, trismus, and swelling than serratiopeptidase drug.
RESUMEN
Introduction Pain, swelling, trismus, and dry socket are common postoperative complications of mandibular third molar surgery (MTMS), which is a routine minor oral surgical procedure. The purpose of this study was to compare the efficacy of the combination of bromelain, rutocide, and trypsin versus serratiopeptidase in reducing postoperative sequelae after MTMS. Materials and methods It was a pilot study conducted from October 2022 to May 2023 in the outpatient department of a private dental institution. Patients with horizontal position C mandibular third molar impaction were enrolled, and a surgical procedure was performed. Patients were divided into two groups. Group A received tab Rutocide D (trypsin 48mg, bromelain 90mg, rutoside 100mg, and diclofenac 50mg) twice daily, and Group B received tab Zerodol SP (aceclofenac 100mg, paracetamol 325mg, and serratiopeptidase 15mg) twice daily in the postoperative period of five days. Outcome parameters like pain, using the visual analog scale (VAS), and mouth opening, were measured on postoperative days one and seven. An Excel spreadsheet (Microsoft, Redmond, WA, USA) was used for data entry and statistical analysis was performed using SPSS (version 23.0; IBM Corp., Armonk, NY, USA). The patients included in the study were analyzed postoperatively. The statistical significance was set at p < 0.05. An independent sample t-test was used to assess the variables between groups. Results The data analyzed showed that the pain perception in Group A was less when compared to Group B. On postoperative day one, the mean VAS score in Group A was 4.0 ± 0.3 and in Group B was 5.2 ± 0.4. On postoperative day seven the mean VAS score in Group A was 1.4 ± 0.43 and in Group B was 3.0 ± 0.4. The results were statistically significant with less pain experienced by participants in Group A compared to participants in Group B on both postoperative day one and postoperative day seven. On the first postoperative day, patients in Group A had a mean mouth opening of 33.68 ± 1.42, whereas patients in Group B had a mean mouth opening of 29.41 ± 1.86, which was statistically significant. Similarly, on postoperative day seven, patients in Group B had a mean mouth opening of 31.73 ± 3.27, whereas patients in Group A had a mean mouth opening of 36.32 ± 0.24, which was statistically significant. Conclusion It is concluded that the proteolytic enzyme combination of trypsin, bromelain, and rutocide is more efficacious than serratiopeptidase in reducing postoperative sequelae after MTMS.